Provider Demographics
NPI:1518315845
Name:WALSH, SHAYLEA (MS, SLP-CFY)
Entity Type:Individual
Prefix:
First Name:SHAYLEA
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MS, SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SPRINGER AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54740-8806
Mailing Address - Country:US
Mailing Address - Phone:715-639-2911
Mailing Address - Fax:
Practice Address - Street 1:232 SPRINGER AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:WI
Practice Address - Zip Code:54740-8806
Practice Address - Country:US
Practice Address - Phone:715-639-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist